Inpatient cardiac risk management program promotes lifestyle changes
NEW ORLEANS – Can hospitalized cardiac patients learn how to reduce their risk of future heart events – and put this knowledge to practical use? And will any therapeutic lifestyle changes (TLC) that are promoted in the acute hospital setting's "teachable moment" be sustained once the patient is back at home?
According to research presented today at the American College of Cardiology's 53rd Scientific Sessions Depression in New Orleans by Emory Heart Center cardiologists, there's reason to believe the answers to those questions is "yes".
The Emory researchers studied the results of the STARR (Steps to Achieve Risk Reduction) program at Emory University Hospital in Atlanta designed to improve patient knowledge of cardiac risk factors and promote TLC changes. "Despite significant evidence that secondary preventive strategies benefit patients with coronary disease, registry data and literature reviews suggest that a majority of the patients are still not in compliance with the American Heart Association/American College of Cardiology guidelines. The STARR program offers inpatient strategies to implement these guidelines and close the gap between physician knowledge and practice," says Laurence S. Sperling, MD., Director of Preventive Cardiology at Emory and co-author of the Emory STARR study.
Based on the most recent literature and AHA/ACC recommendations, the STARR program uses an algorithmic approach to identify individual cardiac risk factors (diabetes, smoking, hypertension, obesity, high saturated fat diets, low physical activity, high LDL, low HDL, high triglycerides, and high stress) and modulate them through a multifactorial team approach. Patients are educated about their individual risk factors and their management through classes, team education, and booklets. Patient education is reinforced with educational booklets, magnets, stickers, and patient contracts.
"Our pilot data suggests that the STARR inpatient program can improve patient knowledge of TLC and help promote improved adherence to these goals, especially with regards to diet and exercise," says Dr. Sperling, Director of the Emory HeartWise Risk Reduction Program. "The impact of such a program could have enormous significance if implemented nation-wide when you consider that the majority of recurrent heart attacks could be prevented and five year mortality significantly decreased if there was strict patient adherence to secondary prevention guidelines and therapeutic lifestyle changes."
Prior to the initiation of the STARR program, a control group of 18 patients underwent phone interviews five months after discharge. Patients were evaluated separately on their knowledge of risk reduction goals and self-reported compliance with diet and exercise. After the STARR program was started, 30 patients were followed five months after discharge to assess the impact of the program on knowledge and behavioral compliance with risk reduction.
The results show that the STARR patients' knowledge of exercise and diet goals was 56.7% versus 18.2% for the control group . The STARR patients' exercise and diet compliance was 67% versus 43.5% in the control group. "While improvement in medication guideline adherence has been demonstrated through other inpatient hospital based programs, the STARR program is the first inpatient program to demonstrate therapeutic lifestyle change in regards to diet and exercise, " Dr. Sperling notes.
There was also a trend toward improvement in weight loss, stress, blood pressure, diabetes control and lipid goals in the STARR patients. "Although this trend was statistically not significant, it might well become more definitive over time," says Dr. Sperling. "The bottom line is that patient compliance was better and the risk factors were moving in the right direction. Further follow up will assess if these positive outcomes are maintained. Over the long term, we would expect that the STARR approach should lower cardiac morbidity and mortality."
In addition to Dr. Sperling, the Emory STARR research team included Emory cardiologists Joseph Miller III, MD; Michael McDaniel, MD; and Deborah Wright of Emory University.
Source: Eurekalert & othersLast reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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